A split-face comparison of cold compress application and electrocautery in upper eyelid blepharoplasty

Aims: To compare the effects of intraoperative electrocautery and cold compress application on postoperative edema and ecchymosis in upper eyelid blepharoplasty using a split-face design. Methods: This prospective, observer-blinded, split-face study included 45 patients (90 eyelids) who underwent bilateral upper eyelid blepharoplasty. In each patient, the right eyelid was treated with electrocautery, in which haemostasis was achieved using bipolar cautery, while the contralateral left eyelid was treated with cold compress application, in which sterile cold compresses were applied for bleeding control without the use of cautery. Postoperative edema and ecchymosis were assessed at the 1-hour, 1-day, and 1-week postoperative time points using standardized photographs evaluated by a blinded observer. The severity of edema and ecchymosis was graded using a 5-point scale. Given the paired nature of the split-face design, statistical analyses were performed using the Wilcoxon signed-rank test, and a p value 0.05 for all comparisons). In contrast, ecchymosis scores were significantly lower in the electrocautery-treated eyelids at the 1-hour postoperative assessment (p=0.03), whereas no statistically significant differences were observed at the 1-day and 1-week evaluations (p>0.05 for both).Conclusion: Intraoperative cold compress application resulted in postoperative edema and ecchymosis outcomes comparable to those achieved with electrocautery during upper eyelid blepharoplasty. Within the limitations of this exploratory split-face study and short-term follow-up, cold compress may be considered a tissue-sparing adjunct in selected cases, particularly beyond the immediate postoperative period. Larger, prospective studies incorporating long-term outcomes and patient-reported measures are warranted to further define its clinical role.